rnRevista de NutriçãoRev Nutr1415-52731678-9865Pontifícia Universidade Católica de Campinas0300910.1590/1678-9865202336e220227ORIGINAL | Collective HealthCharacterization of the dietary and sociodemographic profile of a group of Colombian vegetarian women in childbearing age during the period 2021-2022Caracterização do perfil alimentar e sociodemográfico de um grupo de mulheres vegetarianas colombianas em idade fértil no período 2021-20220000-0003-0609-205XCombarizaManuela Callestudy designdata analysis and interpretation10000-0001-6055-0563RestrepoMaría Camila Lópezdata collectiondata search10000-0002-2348-7582CarvajalMariana Aramburodata collectionanalysis10000-0001-7278-1203ArroyaveNatália Zuluagastudy design final review10000-0001-5755-0431RestrepoMariana Restrepostudy design10000-0002-5618-2056VelásquezSantiago Gómezanalysisdata interpretation1Universidad CESFacultad de Ciencias de la Nutrición y los AlimentosPrograma de Nutrición y DietéticaPobladoMedellínColombiaUniversidad CES, Facultad de Ciencias de la Nutrición y los Alimentos, Programa de Nutrición y Dietética. Poblado, Medellín, ANT, Colombia.
Carla Cristina Enes
The authors declare that they have no conflicts of interest.
Correspondence to: SG VELASQUEZ. E-mail: sagomez@ces.edu.co. 002023202336e220227201020221302202303052023This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.ABSTRACTObjective
To determine the dietary and sociodemographic profile of vegetarian women of childbearing age (18 and 49 years) from the Valle de Aburrá Metropolitan Area in 2021-2022
Methods
Through an online survey, 232 vegetarian and vegan women of childbearing age (18 to 49 years) from the Valle de Aburrá Metropolitan Area were surveyed regarding their sociodemographic characteristics, amount of time following this eating pattern and, type and reason for choosing vegetarianism, physical activity, use of nutritional supplements and frequency of consumption of certain food groups. Descriptive analyses, association of variables with the type of vegetarianism and multinomial regression models were performed.
Results
A total of 232 vegetarian women were surveyed: 60.8% were between 18 and 30 years of age and belonged mainly to the middle class. According to the type of diet, 68.1% used an ovo-lacto-vegetarian diet, 18.1% were vegan, 9.0% lacto-vegetarian and 4.8% ovo-vegetarian. Among the factors evaluated in their potential relationship with the different types of vegetarianism, it is highlighted that vitamin B12 supplementation presents a statistically significant association when using veganism as a comparison category.
Conclusion
According to the results, among young female adults the vegetarian eating style predominates, without significant differences as to the educational level, adequate levels of physical activity in most of the population; there was a higher prevalence of ovo-lacto-vegetarianism. Vitamin B12 supplementation was significantly higher in the vegan population, indicating that ovo-lacto and ovo-vegetarian populations may be at high risk of vitamin B12 deficiency.
RESUMOObjetivo
O estudo objetivou determinar a associação entre o perfil sociodemográfico e alimentar de mulheres vegetarianas em idade fértil (18 a 49 anos) na região metropolitana de Valle de Aburrá (Colômbia) em 2021-2022.
Métodos
Por meio de um questionário online, 232 mulheres vegetarianas e veganas em idade fértil (18 a 49 anos) pertencentes à região metropolitana de Valle de Aburrá foram entrevistadas sobre suas características sociodemográficas, tempo, tipo e motivo da escolha do vegetarianismo, atividade física, consumo de suplementos nutricionais e frequência de consumo dos grupos dos alimentos. Foi realizada análise descritiva, associação das variáveis com o tipo de vegetarianismo e modelos de regressão multinomial.
Resultados
Foram entrevistadas 232 mulheres vegetarianas: 60,8% tinham entre 18 e 30 anos e pertencem principalmente à classe social média. De acordo com o tipo de dieta, 68,1% tinham uma dieta ovolactovegetariana; 18,1%, vegana; 9%, lactovegetariana; e 4,8%, ovovegetariana. Entre os fatores avaliados em sua possível relação com os diferentes tipos de vegetarianismo, destaca-se que a suplementação de vitamina B12 apresenta associação estatisticamente significativa ao ter o veganismo como categoria de comparação.
Conclusão
De acordo com os resultados, entre mulheres adultas jovens, predomina o estilo alimentar vegetariano, sem diferença significativa observada no nível de escolaridade e níveis adequados de atividade física na maioria da população; há também maior prevalência de ovolactovegetarianismo. A suplementação de vitamina B12 é significativamente maior na população vegana, indicando um alto risco de deficiência nas populações ovolacto e ovovegetarianas.
KeywordsDiet, veganDiet, vegetarianNutrientsPublic healthWomen’s healthPalavras-chaveDieta veganaDieta vegetarianaNutrientesSaúde públicaSaúde da mulherINTRODUCTION
Vegetarians’ eating patterns are characterized by the exclusion of meat and fish from the diet and vegans by the exclusion of all foods of animal origin; both diet categories have grown significantly in the population in recent years for different reasons, including interest in animal welfare, desire to protect the environment, lower risk of disease or as an alternative to manage underlying health conditions [1,2].
To date, statistical data of the vegetarian population are incipient, and cover limited geographical areas, especially in developed countries. According to Ipsos (2021), research on food consumption has classified the world population in groups according to the quantity and quality of protein and fat consumed: they include 73% omnivorous, 14% flexitarians (occasional consumption of chicken and fish), 5% vegetarians, 3% vegans and 3% pescatarians [3].
Interest in vegetarian patterns has increased exponentially worldwide. The number of vegetarians in Portugal increased by 400% in the last decade, Italy experienced an increase of 94% from 2011 to 2016 and in Canada veganism was a search trend in the year 2017. In connection with the above, the alternative proteins industry increased 3.1 billion in 2020, corresponding to 3 times more than in any year of that industry’s history and in a supermarket chain in the United Kingdom, the sale of vegetarian foods increased by 500% in January 2022, compared to the same month in 2021 [4].
For Colombia, the information available regarding vegetarian practices is limited and in fact it is a subject that is not yet considered in national surveys; unofficial sources such as Portafolio magazine, report that 8% of the Colombian population is flexitarian, 4% is vegetarian and 2% is vegan [5]. According to Google Trends statistics, the interest or search for the term veganism in Colombia over time has gone from a score below 25 in 2004 to more than 80 by 2020 (100 is the maximum popularity of a term in Google Trends) [6].
Despite the benefits of veganism that have been described, some studies indicate that these eating patterns, with inadequate supervision of a Dietitian Nutritionist, can actually be deficient in macro and micronutrients such as proteins, vitamin B12, vitamin D, iron, zinc, calcium, omega 3, among others [7], generating high health risks, especially in populations such as women of childbearing age who initiate a life cycle through preconception programming since they would determine the nutritional and health conditions of their children through food, given the importance of maternal nutrition in the growth and development of children starting with the intrauterine conditions, which may predispose to the development of non-communicable chronic diseases such as obesity, diabetes, cardiovascular diseases and delays in neurodevelopment [8]. Some studies show high prevalence of malnutrition in vegan women during pregnancy due to the lack of supplementation and adequate monitoring by health professionals who are experts in the subject [9].
Due to the lack of information, it is necessary to identify and characterize this population in different regions of Colombia, which will serve as a basis for the characterization of potential nutritional deficiencies with their subsequent interventions based on the evaluation of socioeconomic and cultural conditions, motivations, and Consumption patterns. On the other hand, this population will benefit from the industry formulating new products aimed especially at satisfying that population nutritional needs; at governmental level the benefit will be the generation of new policies and projects that can promote their inclusion; and finally, there would be benefits to the health sector that would adopt protocols and the development of special treatments for that population.
To begin the characterization of one of the regions in Colombia, the present study aimed to determine the dietary and sociodemographic profile of vegetarian women of childbearing age (18 to 49 years) from the Metropolitan Area of the Aburrá Valley in the year 2021-2022.
METHODS
Considering the procedural and ethical difficulties involved in experimental research with nutritional interventions and based on the availability of contacts linked to nutrition and health from the CES University, a cross-sectional descriptive observational study was carried out with non-probabilistic sampling, using a questionnaire with closed-ended questions as a tool for the collection of information.
This was a cross-sectional descriptive observational study carried out with 232 women aged between 18 and 49 years who experienced at least 1 year of some type of vegetarianism; they were recruited by convenience sampling during the years 2021 and 2022. This investigation was approved by the Research Ethics Committee of the CES University and according to article 11 of Resolution 8430 of 1993 (code Ae-635, approved the 7th of May 2021), it was classified as a project without risk because there were no interventions or modifications of the participants’ biological, physiological, psychological, or social variables.
The inclusion of the participants was carried out by invitations through social networks, placement in vegan restaurants and referral to nutritionists who take care of vegetarian and vegan patients. Through the invitation, the stakeholders indicated their name, telephone number, and email to later be contacted by the research group to schedule the interview date for the completion of the questionnaire. As inclusion criteria, the participants had to be women of childbearing age between 18 and 49 years of age, residents of the Valle de Aburrá Metropolitan Area, who until then had followed a lacto-vegetarian, ovo-vegetarian, ovo-lacto-vegetarian, or vegan diet for a minimum period of one year. The exclusion criteria included pregnant women or women with underlying diseases such as cancer, autoimmune diseases, kidney diseases, among others.
Upon the invitation to participate, 473 individuals signed up, of which 266 could be contacted and answered the survey questionnaire; at the closing time, one of the members of the research group, either nutritionist or a student of the last semesters of the college nutrition course, was connected on line with the purpose of assisting the participant by completing the questionnaire, which was elaborated by the investigators using the Google Forms platform. In the survey, questions were asked about voluntary participation, sociodemographic data, level of physical activity, health history, characteristics of vegetarian or vegan food, consumption of dietary supplements and frequency of consumption of different foods. The answer options were: daily, weekly, monthly, occasionally or never for food groups such as dairy products, vegetables, tubers, fruits, vegetables, animal fats, vegetable fats, dried fruits, seeds, legumes, sweets, whole meal flours, refined flour, alcoholic beverages and water (Charts 1 and 2).
Informed consent.
Characterization of the dietary and sociodemographic profile of a group of Colombian vegetarian women in childbearing age during the period 2021-2022
Thank you for wishing to participate in this survey. The reason for its realization is a project that seeks to characterize the dietary and sociodemographic profile of women of childbearing age who are of legal age (18 to 49 years old vegetarians of the Metropolitan Area in 2021 - 2022). Participation in this study is voluntary; therefore, you may decide not to participate or withdraw at any time, for any reason.It is essential that you understand this information so that your choice or decision to participate is taken freely. The data obtained will be kept confidential and its use will be restricted only to the investigation group; once the study is completed, they will be destroyed; the results obtained in this investigation are academic and professional and have no economic claim, nor is there a conflict of interest involved. They will only be presented at academic events and scientific publications, without mentioning the names of the participants.The general objective or what is intended with this research project is: to determine the dietary and sociodemographic profile of vegetarian women of childbearing age and of legal age (18 to 49 years) in the Metropolitan Area, which will allow further studies to be carried out in the future, promote the implementation of new programs and the development of new products aimed at the vegetarian population of the city.Your participation consists of completing this online survey that will include general information, sociodemographic data, consumption frequency, and vegetarianism characterization questionnaires.Email address*Considering that participation in this study is completely voluntary, do you agree to participate?□ Yes□ No
Dietary and sociodemographic questionnaire.
Characterization of the dietary and sociodemographic profile of a group of Colombian vegetarian women in childbearing age during the period 2021-2022
Next, we will ask you about some sociodemographic characteristics.1. What is your identification number? (This question is asked only for the purpose of analyzing and filtering the answers obtained)2. What is your birth date? Month / Day / Year3. What is your country of birth? □ Colombia □ Other: _________________4. In which district do you live? □ District 1 (Popular) □ District 2 (Santa Cruz) □ District 3 (Manrique) □ District 4 (Aranjuez) □ District 5 (Castilla) □ District 6 (12 de Octubre) □ District 7 (Robledo) □ District 8 (Villa Hermosa) □ District 9 (Buenos Aires) □ District 10 (La Candelaria) □ District 11 (Laureles-Estadio) □ District 12 (La América) □ District 13 (San Javier) □ District 14 (El Poblado) □ District 15 (Guayabal) □ District 16 (Belén)5. How long have you been living in Medellín? □ Less than 1 year □ Between 1 and 5 years □ More than 10 years □ Since birth6. Which phone number can we use to contact you for future investigations? ____________________7. What is your current level of education? □ Primary □ Secondary □ College □ Technologist Technician □ Undergraduate □ Postgraduate □ No schooling8. What socioeconomic stratum do you belong to? □ Stratum 1 □ Stratum 2 □ Stratum 3 □ Stratum 4 □ Stratum 5 □ Stratum 69. Do you identify with any of the following religions? □ Christianity □ Catholicism □ Hinduism □ Judaism □ Islamism □ Buddhism □ Spiritual □ Atheist □ Other: _____________10. Do you do more than 150 minutes of physical activity per week? □ Yes □ No11. Do you have any of these underlying conditions? □ Dyslipidemia (alterations such as: total cholesterol, triglycerides, reduced LDL and HDL cholesterol) □ Diabetes □ Hypertension □ Obesity (Body Mass Index (BMI) greater than 30 kg/m2) □ History of cardiovascular diseases (heart attack, stroke, aneurysm arterial disease of the extremities) □ Chronic kidney disease □ None of the above12. Are you currently pregnant? □ Yes □ No13. Are you vegetarian or vegan? □ Yes □ No14. How long have you been vegetarian or vegan? □ Less than 1 year □ Between 1 and 2 years □ Between 2 and 4 years □ More than 5 years15. Did you choose to be a vegetarian or vegan for any of these reasons? □ It is a type of food that helps the environment □ It is a healthier diet □ Out of respect for animals □ Because you don’t like meat □ Other: _________________________________________16. What kind of vegetarianism do you identify with? □ Ovo-lacto-vegetarian (You do not eat meat, poultry or fish) □ Lacto-vegetarian (You do not eat eggs, meat, poultry or fish) □ Ovo-vegetarian (You do not eat meat, chicken, fish or dairy) □ Vegan (You do not eat meat, poultry, fish, dairy, eggs, gelatin, honey, or wear woolen clothes) □ Other: _________________________________________17. Do you take any kind of supplement? □ Yes □ No18. If the answer above is yes, what supplement(s) do you take? ____________________________________________________19. Do you have or have you had advice from a professional on your diet? □ Yes □ NoConsumption frequencyNext, we’ll ask you how often you eat certain food groups.20. How often do you consume full-fat dairy (whole milk, full-fat yogurt, mozzarella cheese, curd)? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never22. How often do you eat eggs? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never23. How often do you eat meat? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never24 How often do you consume greens and/or vegetables? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never25. How often do you eat fruit? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never26. How often do you eat nuts (almonds, hazelnuts, chestnuts, peanuts, macadamia nuts)? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never27. How often do you eat legumes (beans, peas, chickpeas)? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never28. How often do you consume olive oil? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never29. How often do you consume other fats such as butter, other types of vegetable and animal oils? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never30. How often do you eat whole grains flour (brown rice, whole wheat flour, barley, oats)? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never31. How often do you eat sweets (desserts, cakes, sweet foods)? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never32. How often do you drink alcoholic beverages? □ From 1 to 3 times a day □ From 3 to 5 times a day □ Once a week □ 1 to 3 times a month □ Never or almost never33. What is the number of glasses of water you drink per day? □ 2 glasses □ 4 glasses □ 6 glasses □ More than 8 glasses
Jamovi version 1.6.23 software was used for the collection and review of information. The results are presented as Mean (M) ± Standard Deviation (SD) and as a percentage of the total population.
The Chi square test was used to compare the differences between the frequencies of the comparison groups. Values p≤0.05 were considered as statistically significant. Multinomial regression models were used to analyze the association between both the dietary profile and the sociodemographic profile with the type of vegetarianism.
RESULTSSociodemographic characterization
From the review of the data obtained from 232 vegetarian women between the ages of 18 and 49 years, it was found that in the Aburrá Valley (Medellín, Colombia) 60.8% of the population was between 18 and 30 years old, 31% between 30 and 40 years. A total of 97.9% were born in Colombia. Regarding the educational level, 35.8% were graduates, 36.2% undergraduates and the remaining 28% postgraduates. Regarding socioeconomic class, the sample included mainly the middle class (60.7%) and 57% of the sample self-described as religious; 65.9% of the participants complied with the minimum time of physical activity recommended by the World Health Organization consisting of 150 minutes per week. Regarding the type of diet, 68.1% followed an ovo-lacto-vegetarian diet, 18.1% were vegan, 9% lacto-vegetarian and 4.8% ovo-vegetarian. Finally, concerning vitamin B12 supplementation, it was found that 60.4% of the 232 women supplemented their diet with said vitamin (Table 1) [10].
Sociodemographic characteristics of the participants. Medellín, Colombia, 2021-2022.
Variable*
n
%
Age (years)
18-30 years
141
60.8
30-40 years
72
31
41-49 years
19
8.2
Country of birth
Brazil
1
00.4
Colombia
227
97.9
USA
1
00.4
Venezuela
3
01.3
Level of study
Graduated
83
35.8
Undergraduate
84
36.2
Postgraduate
65
28
Social stratum
Low
17
07.4
Medium
141
60.7
High
74
31.9
Religion
Religious
132
57
Agnostic
50
21.5
Atheist
50
21.5
Physical activity
Yes
153
65.9
No
79
34.1
Type of vegetarianism
Lacto-vegetarian
21
9
Ovo-lacto-vegetarian
158
68.1
Ovo-vegetarian
11
04.8
Vegan
42
18.1
B12 supplementation
Yes
140
60.4
No
92
39.6
Note:
n=232.
Association between both the dietary profile and the sociodemographic profile with the type of vegetarianism
Table 2 shows the association between both the dietary profile and the sociodemographic profile with the type of vegetarianism. Among the variables with statistically significant associations between the proportions of their categories and the type of vegetarian diet are the frequency of consumption of whole meal flours (p-value=0.008), frequency of consumption of seeds (p-value=0.002), and B12 supplementation (p-value=<0.001).
Association between the dietary and sociodemographic profiles with the type of vegetarianism in the study population. Medellín, Colombia, 2021-2022.
Variable
Total n (%)
Lacto-vegetarian
Ovo-lacto-vegetarian
Ovo-vegetarian
Vegan
p-value
21 (9.0%)
158 (68.1%)
11 (4.8%)
42 (18.1%)
Level of the study
Graduate
83 (35.8)
7 (33.3)
58 (36.7)
2 (18.1)
16 (38.1)
0.764
Undergraduate
84 (36.2)
9 (42.9)
53 (33.4)
5 (45.5)
17 (40.5)
Postgraduate
65 (28)
5 (23.8)
47 (29.7)
4 (36.4)
9 (21.3)
Socioeconomic stratum
Low
17 (7.3)
1 (4.8)
9 (5.7)
1 (9.1)
6 (14.3)
0.376
Medium
132 (56.9)
10 (47.6)
92 (58.2)
8 (72.7)
22 (52.4)
High
83 (35.8)
10 (47.6)
57 (36.1)
2 (18.2)
14 (33.3)
Religion
Religious
132 (56.9)
14 (66.7)
88 (55.6)
7 (63.6)
23 (54.8)
0.782
Agnostic
50 (21.5)
3 (14.3)
38 (24.1)
2 (18.2)
7 (16.7)
Atheist
50 (21.6)
4 (19)
32 (20.3)
2 (18.2)
12 (28.5)
Physical activity
Yes
153 (65.9)
17 (81)
103 (65.2)
9 (81.8)
24 (57.1)
0.185
No
79 (34.1)
4 (19)
55 (34.8)
2 (18.2)
18 (42.9)
Frequency of legumes consumption
Diary
171 (73.7)
17 (81)
109 (69)
9 (81.8)
36 (85.7)
0.117
Weekly
61 (26.3)
4 (19)
49 (31)
2 (18.2)
6 (14.3)
Frequency of whole meal flours consumption
Diary
89 (38.4)
14 (66.7)
47 (29.7)
5 (45.5)
23 (54.8)
0.008*
Weekly
106 (45.6)
5 (23.8)
82 (51.9)
5 (45.5)
14 (33.3)
Occasional
37 (15.9)
2 (9.5)
29 (18.4)
1 (9)
5 (11.9)
Frequency of sweets consumption
Diary
111 (47.8)
7 (33.3)
81 (51.3)
7 (63.6)
16 (38.1)
0.150
Weekly
81 (35)
10 (47.7)
55 (34.8)
1 (9.1)
15 (35.7)
Occasional
40 (17.2)
4 (19)
22 (13.9)
3 (27.3)
11 (26.2)
Frequency of fruit consumption
Diary
196 (84.5)
17 (81)
132 (83.5)
10 (90.9)
37 (88.1)
0.784
Weekly
36 (15.5)
4 (19)
26 (16.5)
1 (9.1)
5 (11.9)
Frequency of nuts consumption
Diary
119 (51.3)
13 (61.9)
75 (47.5)
8 (72.7)
23 (54.8)
0.480
Weekly
82 (35.3)
7 (33.3)
58 (36.7)
2 (18.2)
15 (35.7)
Occasional
31 (13.4)
1 (4.8)
25 (15.8)
1 (9.1)
4 (9.5)
Frequency of seed consumption
Diary
91 (39.2)
12 (57.2)
47 (29.8)
7 (63.6)
25 (59.6)
0.002*
Weekly
86 (37.1)
5 (23.9)
65 (41.1)
2 (18.2)
14 (33.3)
Occasional
55 (23.7)
4 (19)
46 (29.1)
2 (18.2)
3 (7.1)
Frequency of alcoholic beverages intake
Weekly
46 (19.8)
4 (19)
31 (19.6)
2 (18.2)
9 (21.4)
0.992
Occasional
157 (67.7)
15 (71.5)
108 (68.4)
7 (63.6)
27 (64.3)
Never
29 (12.5)
2 (9.5)
19 (12)
2 (18.2)
6 (14.3)
Professional advice
Yes
153 (65.9)
15 (71.4)
102 (64.6)
8 (72.7)
28 (66.7)
0.884
No
79 (34.1)
6 (28.6)
56 (35.4)
3 (27.3)
14 (33.3)
B12 supplementation
Yes
140 (60.3)
13 (61.9)
83 (52.5)
5 (45.5)
39 (92.9)
<0.001*
No
92 (39.7)
8 (38.1)
75 (47.5)
6 (54.5)
3 (7.1)
Protein supplementation
Yes
40 (17.2)
6 (28.6)
28 (17.7)
2 (18.2)
4 (9.5)
0.299
No
192 (82.8)
15 (71.4)
130 (82.3)
9 (81.8)
38 (90.5)
Vitamin D supplementation
Yes
25 (10.8)
2 (9.5)
17 (10.8)
1 (9.1)
5 (11.9)
0.989
No
207 (89.2)
19 (90.5)
141 (89.2)
10 (90.9)
37 (88.1)
Iron supplementation
Yes
29 (12.5)
1 (4.8)
22 (13.9)
2 (18.2)
4 (9.5)
0.550
No
203 (87.5)
20 (95.2)
136 (86.1)
9 (81.8)
38 (90.5)
Note:
significant at p<0.05. *The p-value is based on the Chi Square test of normality.
Odds ratio adjusted for type of vegetarianism according to sociodemographic and dietary variables.
Table 3 shows the results of the multinomial regression model used to review the association between the dietary profile and the sociodemographic profile with respect to the type of diet, taking veganism as a reference. In the case of the comparison between the lacto-vegetarian and vegan diet, a statistically significant negative association was found for the B12 supplementation variable [OR adj = 0.064 (0.011–0.347)], which means that the odds of being a lacto-vegetarian who supplements with this vitamin is less than 94% of a vegan who does not supplement.
Odds ratio adjusted for the type of vegetarianism according to sociodemographic and dietary variables. Medellín, Colombia, 2021-2022.
Variables
β
Lacto-vegetarian vs vegan
p-value
β
Ovo-lacto-vegetarian vs vegan
p-value
β
Ovo-vegetarian vs vegan
p-value
OR adj (95% IC)
OR adj (95% IC)
OR adj (95% IC)
Age (years)
18-30
(reference)
(reference)
(reference)
31-40
-1.585
0.0.535(0.012-22.199)
0.099
-1.121
0.325(0.085-1.237)
0.099
0.180
1.197(0.114-12.522)
0.880
41-49
-2.328
0.097(0.006-1.362)
0.084
-2.540
0.078(0.010-0.577)
0.012*
2.614
13.652(0.481- 386.930)
0.126
Level of the study
Graduate
(reference)
(reference)
(reference)
Undergraduate
0.338
1.402(0.318-6.181)
0.655
0.087
1.091(0.383-3.107)
0.870
0.909
2.484(0.226-27.254)
0.457
Postgraduate
1.412
1.412(0.476-35.376)
0.199
1.582
4.865(1.041-22.728)
0.044*
0.514
1.672(0.095-29.171)
0.725
Socioeconomic stratum
Low
(reference)
(reference)
(reference)
Medium
1.623
5.068(0.316-81.249)
0.252
1.639
5.153(0.925-28.685)
0.061
0.794
2.212(0.094-51.558)
0.621
High
1.746
5.734(0.354-92.894)
0.219
1.421
4.144(0.714-24.042)
0.113
-0.227
0.796(0.028-22.254)
0.893
Religion
Religious
(reference)
(reference)
(reference)
Agnostic
-1.273
0.280 (0.045-1.732)
0.171
-0.421
0.656(0.200-2.147)
0.486
-0.691
0.500(0.052-4.774)
0.548
Atheist
-1.153
0.314(0.063-1.567)
0.158
-0.650
0.521(0.184-1.475)
0.220
-0.729
0.482(0.045-5.132)
0.546
Physical activity (>150 min per week)
No
(reference)
(reference)
(reference)
Yes
0.896
2.451(0.551-10.905)
0.239
-0.024
0.961(0.395-2.656)
0.961
1.378
3.968(0.482-32.625)
0.200
Frequency of legumes consumption
Daily
(reference)
(reference)
(reference)
Weekly
0.499
1.648(0.324-8.365)
0.547
0.958
2.608(0.861-7.896)
0.090
1.034
2.814(0.279-28.312)
0.380
Frequency of whole meal flours consumption
Daily
(reference)
(reference)
(reference)
Weekly
-0.815
0.442(0.095-2.038)
0.295
0.776
2.174(0.813-5.816)
0.122
1.299
3.667(0.386-34.762)
0.167
Occasional
-0.877
0.4157(0.047-3.636)
0.428
0.406
1.502(0.371-6.074)
0.568
-1.011
0.363(0.013-9.817)
0.380
Frequency of sweets consumption
Daily
(reference)
(reference)
(reference)
Weekly
0.458
1.581(0.382-6.545)
0.527
-0.011
0.988(0.360-2.712)
0.982
-2.950
0.052(0.002-1.103)
0.058
Occasional
-0.361
0.696(0.118-4.091)
0.689
-1.208
0.298(0.089-0.993)
0.049*
-0.932
0.393(0.049-3.117)
0.377
Frequency of fruit consumption
Daily
(reference)
(reference)
(reference)
Weekly
1.776
5.908(0.863-40.449)
0.070
0.596
1.816(0.467-7.062)
0.389
0.771
2.163(0.099-47.250)
0.624
Frequency of nuts consumption
Daily
(reference)
(reference)
(reference)
Weekly
-0.713
0.489(0.112-2.129)
0.341
-0.513
0.598(0.213-1.676)
0.329
-1.662
0.189(0.016-2.223)
0.186
Occasional
-2.306
0.099(0.004-2.110)
0.139
-0.898
0.407(0.077-2.147)
0.290
0.012
1.013(0.035-28.675)
0.994
Frequency of seed consumption
Daily
(reference)
(reference)
(reference)
Weekly
0.105
1.110(0.242-5.096)
0.892
0.895
2.448(0.874-6.860)
0.088
-0.952
0.385(0.031-4.670)
0.454
Occasional
1.849
6.356(0.700-57.68)
0.100
2.423
11.285(2.260-56.337)
0.003*
1.240
3.458(0.200-59.677)
0.393
Frequency of alcoholic beverages intake
Weekly
(reference)
(reference)
(reference)
Occasional
0.177
1.194(0.235-6.058)
0.830
0.169
1.185(0.385-3.642)
0.767
0.715
2.045(0.150-27.858)
0.591
Never
-0.250
0.778(0.068-8.781)
0.839
0.092
1.096(0.220-5.464)
0.910
-0.212
0.808(0.033-19.789)
0.896
Professional advice
No
(reference)
(reference)
(reference)
Yes
0.434
1.544(0.379-6.284)
0.544
-0.182
0.833(0.324-2.142)
0.705
0.538
1.713(0.234-12.515)
0.595
B12 supplementation
No
(reference)
(reference)
(reference)
Yes
-2.747
0.064(0.011-0.347)
0.001*
-2.775
0.062(0.015-0.250)
<0.001*
-3.348
0.035(0.004-0.297)
0.002*
Protein supplementation
No
(reference)
(reference)
(reference)
Yes
1.558
4.749(0.868-25.989)
0.072
1.112
3.041(0.755-12.245)
0.118
1.310
3.706(0.307-44.701)
0.302
Vitamin D supplementation
No
(reference)
(reference)
(reference)
Yes
-0.110
0.894(0.100-7.972)
0.921
0.3740
1.453(0.385-5.482)
0.581
-2.251
0.105(0.008-13.288)
0.362
Iron supplementation
No
(reference)
(reference)
(reference)
Yes
-1.023
0.359(0.028-4.523)
0.428
0.545
1.725(0.462-6.441)
0.417
1.084
2.959(0.187-46.660)
0.441
Note:
significant at p<0.05. *The P value is based on the Chi Square test of normality.
Likewise, when comparing the ovo-lacto-vegetarian diet with respect to the vegan one, it was found that the variables of age [OR adj = 0.078 (0.010–0.577)], frequency of sweets consumption [OR adj = 0.298 (0.089–0.993)] and vitamin B12 supplementation [OR adj = 0.062 (0.015–0.250)] presented a statistically significant negative association; while the variables of study level [OR adj = 4.865 (1.041–22.728)] and frequency of seed consumption [OR adj = 11.285 (2.260–56.337)] presented a statistically significant positive association. From the above it is highlighted that, similar to lacto-vegetarian diets, the odds for an ovo-lacto-vegetarian person who uses B12 supplement is 93% lower than a vegan person who does not use that supplement. Likewise, the odds of being ovo-lacto-vegetarian in individuals who consume sweets occasionally is 70% lower than a vegan person who consumes them occasionally. Regarding age, the odds of being an ovo-lacto-vegetarian for a person between 41 and 49 years of age is 92% lower than a person between 18 and 30 years of age.
Additionally, statistically significant positive associations were found for the variables of the study level [OR adj = 4.865 (1.041–22.728)] and frequency of seed consumption [OR adj = 4.865 (1.041–22.728)], when comparing the ovo-lacto-vegetarian and vegan diet types. Therefore, the odds of being ovo-lacto-vegetarian in people who consume seeds occasionally is 11.28 times higher than those who consume seeds daily. Finally, when comparing the ovo-vegetarian with the vegan diet, it is observed that only the B12 supplementation variable [OR adj = 0.035 (0.004–0.297)] presented a statistically significant negative association. This means that the odds of being an ovo-vegetarian who supplements with B12 is 96% lower than a vegan who does not use this vitamin supplement.
DISCUSSION
The results of this study provide new insights into the dietary and sociodemographic profile of vegetarian women of childbearing age and of legal age in the Metropolitan Area of Medellín. Regarding the level of study, it was found that most women were undergraduates and postgraduates (84 and 83% respectively and, in terms of social class, the most prevalent was the middle class (60.7%), which is consistent with results of previous studies carried out in the city of Medellín indicating an important purchasing power in this population, which reflects in food security [11].
Regarding the dietary profile, some studies mention that people with a plant-based diet are characterized by a high consumption of fruits and vegetables [12], exceeding the average consumption of these food groups in the whole population. This is supported by the results of this study in relation to fruits, where 84.5% of the total study population consumes fruits daily, which could meet the World Health Organization intake recommendation of at least 400 grams (5 servings a day) between fruits and vegetables [13].
On the other hand, in this study, the consumption of whole grain flours was statistically significant among the different types of vegetarians, a fact similar to that of other studies that indicated that vegetarians consume more wholegrain flours than non-vegetarians [14], This could be because wholegrain flours are a better source of fiber and other nutrients such as the B complex vitamins, iron, folic acid, selenium, potassium, and magnesium [15]. Likewise, flours are used to complement the proteins’ amino acids and facilitate their digestion and absorption [16]. Other studies have found positive associations between the consumption of refined flours during pregnancy and the risk of overweight and obesity, leading to negative results regarding cardiometabolic aspects, which is why it is important to monitor this food group in women of childbearing age [17].
Regarding the consumption of sweets among vegetarians and vegans, it has been found in other studies [18-21] that such consumption tends to be low compared to omnivores. In the results of our study, it was found that, although the consumption of sweets was not statistically significant, 47.8% of the participants stated that they consumed at least 1 sweet once a day. This corroborates the statistics of the World Health Organization where it is evidenced that approximately 48% of the population consumes sweets daily, probably exceeding the World Health Organization recommendations of a maximum consumption of 25 to 45 grams of total sugars per day for an adult [22]. On the other hand, the available evidence suggests that the type and amount of carbohydrates can influence women’s fertility; in this connection, it has been observed that the consumption of a diet rich in foods with a low glycemic load is associated to an improvement in fertility due to ovulation caused by better insulin sensitivity in women [23]. On the other hand, the Nutritional Evaluation Study (NuEva) carried out in Germany, found that the intake of simple carbohydrates was lower in people who ate a vegan diet compared to flexitarians and vegetarians, which supports the result obtained in this study, since when comparing the consumption of sweets between the different types of vegetarianism vs. veganism, it was found that an ovo-lacto-vegetarian diet is more likely to increase sweets consumption compared to a vegan diet [19].
Some investigations have highlighted the low protein intake in dietary patterns based on protein of vegetable origin, especially in vegan patterns [24,25]. This is because foods of vegetable origin are considered a source of incomplete proteins due to their lack of one or more amino acids. However, proteins complete each other by mixing different foods of plant origin; as a general rule, grains, cereals, nuts or seeds can be consumed together with legumes to obtain a complete protein set [26]. This is where the importance of seeds comes into play. Besides providing protein quality in this type of diet, they also provide essential fatty acids such as linoleic acid and alpha linolenic acid [27]. In the present study, a statistically significant association was identified between the consumption of seeds and the type of vegetarianism, with higher consumption in vegan women.
On the other hand, vitamin B12 deficiency is common in individuals who eat a plant-based diet in any of the vegetarianism classifications, since this vitamin is synthesized mainly by microorganisms which are found essentially in foods of animal origin [28]. Deficiency of this vitamin in women of childbearing age can increase the risk of the baby developing neural tube defects and has been associated with risk of preterm delivery and low birth weight [29]. From the results of the present study, a statistically significant difference was found regarding B12 supplementation associated with the different types of vegetarianism, which implies that the vegan population adequately uses supplements of this vitamin, unlike other types of vegetarianism. On the other hand in the Nutritional Evaluation (NuEva) Study which was carried out in Germany, it was found that the daily intake of vitamin B12 was below the recommended levels in both vegans and vegetarians [19]; this same observation was evidenced in a systematic review that evaluated studies that reviewed the intake of foods that are sources of vitamin B12 and the consumption of foods with supplementation, finding in the latter a higher vitamin B12 total intake. However, the intake of sources of vitamin B12 of vegetarians and vegans remained below the recommended nutritional level [30] yet in the present study it was found that vegan individuals had higher vitamin B12 supplementation than other vegetarians. It is important to highlight that in the case of supplementation with protein, iron, and vitamin D, no association was found with the different types of vegetarianism. Although no studies were found that compare the supplementation of these nutrients in this population group, a publication by the Austrian Pediatric and Adolescent Society found that vegans have the lowest intake of vitamin D; Vegetarians in general have a good consumption of foods that are sources of iron, although the iron has less bioavailability and in the case of protein, ovo-lacto-vegetarians receive good quality protein in their diet, unlike vegans, since they do not have all essential amino acids within the composition of their plant-based protein [31].
These patterns may not be extended to all vegetarian women. People choose their diet based on multiple aspects, including culture, emotions, traditions, availability, among other factors. These findings can provide a guide to carry out a more accurate nutritional intervention and guide the innovation of this population’s products, which can satisfy nutritional requirements.
In future studies more food groups should be included as well as taking portion sizes into account to obtain more precise information. Likewise, it should be considered that food frequency may not reflect biochemical parameters; this is why it is recommended to evaluate the biochemical profile of the study population in subsequent studies. Similarly, some studies have associated this type of diet with lower body weight and consequently a lower body mass index; therefore, anthropometric follow-up is suggested in further research [32,33]. The results of this study have limitations in terms of their scope and inference because the chosen sample does not meet the criteria of representativeness in terms of size and type of sampling, due to the difficulties in accessing a population of interest that has still very low prevalence. This study may be the basis for future research since vegetarianism is within the eating and consumption trends.
CONCLUSION
Plant-based eating practices can be part of healthy eating practices without negative effects on health, as long as there is adequate guidance from Nutrition and Dietetics professionals and a balance is maintained in the consumption of the different groups of food and also that nutritional supplementation guidelines are complied with. According to the results in the population assessed, young adults are the ones who adopt most the vegetarian or vegan eating style, with a higher prevalence of ovo-lacto-vegetarianism regardless of significant differences in the educational level and adequate levels of physical activity. It is noteworthy that vitamin B12 supplementation is significantly higher in the vegan population, which means a high risk of vitamin B12 deficiency in ovo-lacto and ovo-vegetarian populations, because foods such as eggs and dairy products do not meet the vitamin B12 supply levels plus the fact that vegetable sources are considered as providers of pseudo vitamin B12 that lack functionality. This investigation only addresses aspects associated with consumption, but it is necessary to carry out further investigations that allow the evaluation of biochemical and anthropometric variables in this and in other population groups.
How to cite this article: Combariza MC, Restrepo MCL, Carvajal MA, Arroyave NZ, Restrepo MR, Velásquez SG. Characterization of the dietary and sociodemographic profile of a group of Colombian vegetarian women in childbearing age during the period 2021-2022. Rev Nutr. 2023;36:e220227. https://doi.org/10.1590/1678-9865202336e220227
REFERENCESShahana AM, Sivakumar A, editors. Sustainable Society: a new beginning. Raleigh: Lulu Publication; 2022.ShahanaAMSivakumarASustainable Society: a new beginningRaleighLulu Publication2022Xiao W, Zhang Q, Yu L, Tian F, Chen W, Zhai Q. Effects of vegetarian diet-associated nutrients on gut microbiota and intestinal physiology. Food Sci H Wel. 2022;11(2):208-17. https://doi.org/10.1016/j.fshw.2021.11.002XiaoWZhangQYuLTianFChenWZhaiQ.Effects of vegetarian diet-associated nutrients on gut microbiota and intestinal physiologyFood Sci H Wel202211220821710.1016/j.fshw.2021.11.002Ipsos. An exploration into diets around the world [Internet]. London: Ipsos; 2021 [cited 2021 May 20]. Available from: https://www.ipsos.com/sites/default/files/ct/news/documents/2018-09/an_exploration_into_diets_around_the_world.pdfIpsosAn exploration into diets around the world [Internet]LondonIpsos20212021 May 20Available from: https://www.ipsos.com/sites/default/files/ct/news/documents/2018-09/an_exploration_into_diets_around_the_world.pdfThe Vegan Society. Worldwide growth of veganism [Internet]. Birmingham: The Vegan Society; 2022 [cited 2021 May 20]. Available from: https://www.vegansociety.com/news/media/statistics/worldwideThe Vegan SocietyWorldwide growth of veganism [Internet]BirminghamThe Vegan Society2022Available from: https://www.vegansociety.com/news/media/statistics/worldwide2021 May 20Portafolio. Seis de cada 10 consumidores colombianos dicen seguir dietas especializadas que omiten ciertos ingredientes [Internet]. El Tiempo Casa Editorial; 2016 Sep 20 [cited 2022 Oct 7]. Available from: https://www.portafolio.co/economia/seis-de-cada-10-colombianos-aseguran-que-estan-a-dieta-500482PortafolioSeis de cada 10 consumidores colombianos dicen seguir dietas especializadas que omiten ciertos ingredientesEl Tiempo Casa Editorial20160920Available from: https://www.portafolio.co/economia/seis-de-cada-10-colombianos-aseguran-que-estan-a-dieta-5004822022 Oct 7Google Trends [Internet]. Veganismo [cited 2022 Oct 14]. Available from: https://trends.google.com/trends/explore?date=all&geo=CO&q=%2Fm%2F07_hyGoogle Trends [Internet]Veganismo2022 Oct 14Available from: https://trends.google.com/trends/explore?date=all&geo=CO&q=%2Fm%2F07_hyAgnoli C, Baroni L, Bertini I, Ciappellano S, Fabbri A, Papa M, et al. Position paper on vegetarian diets from the working group of the Italian Society of Human. Nutr Metab Cardiovasc Dis. 2017; 27(12). https://doi.org/10.1016/j.numecd.2017.10.020AgnoliCBaroniLBertiniICiappellanoSFabbriAPapaMPosition paper on vegetarian diets from the working group of the Italian Society of HumanNutr Metab Cardiovasc Dis2017271210.1016/j.numecd.2017.10.020Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J Acad Nutr Diet. 2014;114(7):1099-1103. https://doi.org/10.1016/j.jand.2014.05.005ProcterSBCampbellCGPosition of the Academy of Nutrition and Dietetics: Nutrition and Lifestyle for a Healthy Pregnancy OutcomeJ Acad Nutr Diet201411471099110310.1016/j.jand.2014.05.005Miedziaszczyk M, Ciabach P, Grześkowiak E, Szałek E. The safety of a vegan diet during pregnancy. Postepy Hig Med Dosw. 2021;75(1):417-25. http://dx.doi.org/10.5604/01.3001.0014.9343MiedziaszczykMCiabachPGrześkowiakESzałekE.The safety of a vegan diet during pregnancyPostepy Hig Med Dosw202175141742510.5604/01.3001.0014.9343Sepúlveda CE, López C, Gallego A, editors. Los límites de la estratificación: en busca de alternativas [Internet]. Bogotá: Editorial Universidad del Rosario; 2014 [cited 2023 Feb 5]. Available from: http://books.scielo.org/id/yn4vhSepúlvedaCELópezCGallegoALos límites de la estratificación: en busca de alternativasBogotáEditorial Universidad del Rosario20142023 Feb 5Available from: http://books.scielo.org/id/yn4vhMoreno N. Seguridad alimentaria en hogares vegetarianos [Internet]. Medellín: Editorial Universidad de Antioquia; 2018 [cited 2023 Feb 5]. Available from: https://bibliotecadigital.udea.edu.co/bitstream/10495/14435/1/MorenoNatalia_2018_SeguridadAlimentariaEstado.pdfMorenoN.Seguridad alimentaria en hogares vegetarianos [Internet]MedellínEditorial Universidad de Antioquia20182023 Feb 5Available from: https://bibliotecadigital.udea.edu.co/bitstream/10495/14435/1/MorenoNatalia_2018_SeguridadAlimentariaEstado.pdfNguyen T-L, Tai DH, Hien LT, Quynh DM, Son PN. A novel model to predict plant-based food choice-empirical study in Southern Vietnam. Sustainability. 2020;12(19):3847. https://doi.org/10.3390/su12093847NguyenT-LTaiDHHienLTQuynhDMSonPNA novel model to predict plant-based food choice-empirical study in Southern VietnamSustainability202012193847384710.3390/su12093847World Health Organization. Alimentación sana [Internet]. Geneve: Organization; 2018 Aug 21 [cited 2022 Oct 14]. Available from: https://www.who.int/es/news-room/fact-sheets/detail/healthy-dietWorld Health OrganizationAlimentación sana [Internet]GeneveOrganization201808212022 Oct 14Available from: https://www.who.int/es/news-room/fact-sheets/detail/healthy-dietBrytek-Matera A. Restrained Eating and vegan, vegetarian and omnivore dietary intakes. Nutrients. 2020;12(7):2133. https://doi.org/10.3390/nu12072133Brytek-MateraA.Restrained Eating and vegan, vegetarian and omnivore dietary intakesNutrients20201272133213310.3390/nu12072133Mayo Clinic Staff. Whole grains: hearty options for a healthy diet [Internet]. Rochester: Mayo Clinic; 2022 Dec 10 [cited 2022 Oct 14]. Available from: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/whole-grains/art-20047826#:~:text=These%20grains%20are%20either%20present,%2C%20selenium%2C%20potassium%20and%20magnesiumMayoClinicWhole grains: hearty options for a healthy diet [Internet]RochesterMayo Clinic202212102022 Oct 14Available from: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/whole-grains/art-20047826#:~:text=These%20grains%20are%20either%20present,%2C%20selenium%2C%20potassium%20and%20magnesiumCleveland Clinic. What are complete proteins? Complete proteins contain all of your essential amino acids [Internet]. Cleveland; 2022 Dec 6 [cited 2022 Oct 14]. Available from: https://health.clevelandclinic.org/do-i-need-to-worry-about-eating-complete-proteins/Cleveland ClinicWhat are complete proteins? Complete proteins contain all of your essential amino acidsCleveland20221262022 Oct 14Available from: https://health.clevelandclinic.org/do-i-need-to-worry-about-eating-complete-proteins/Zhu Y, Olsen S, Mendola P. Maternal dietary intakes of refined grains during pregnancy and growth through the first 7 y of life among children born to women with gestational diabetes. Am J Clin Nutr. 2017;106(1). https://doi.org/10.3945/ajcn.116.136291ZhuYOlsenSMendolaP.Maternal dietary intakes of refined grains during pregnancy and growth through the first 7 y of life among children born to women with gestational diabetesAm J Clin Nutr2017106110.3945/ajcn.116.136291Papier K, Tong T, Appleby P, Bradbury K. Comparison of Major Protein-Source Foods and Other Food Groups in Meat-Eaters and Non-Meat-Eaters in the EPIC-Oxford Cohort. Nutrients. 2019;11(824). https://doi.org/10.3390/nu11040824PapierKTongTApplebyPBradburyK.Comparison of Major Protein-Source Foods and Other Food Groups in Meat-Eaters and Non-Meat-Eaters in the EPIC-Oxford CohortNutrients20191182410.3390/nu11040824Dawczynski C, Weidauer T, Richert C, Schlattmann P, Dawczynski K, Kiehntopf M. Nutrient intake and nutrition status in vegetarians and vegans in comparison to omnivores - the Nutritional Evaluation (NuEva) Study Front Nutr. 2022;9:819106. https://doi.org/10.3389/fnut.2022.819106 DawczynskiCWeidauerTRichertCSchlattmannPDawczynskiKKiehntopfMNutrient intake and nutrition status in vegetarians and vegans in comparison to omnivores - the Nutritional Evaluation (NuEva) StudyFront Nutr2022981910681910610.3389/fnut.2022.819106Beezhold B, Radnitz C, Rinne A, Di Matteo J. Vegans report less stress and anxiety than omnivores. Nutr Neurosci. 2015;(7):289-96. https://doi.org/10.1179/1476830514Y.0000000164BeezholdBRadnitzCRinneADi MatteoJ.Vegans report less stress and anxiety than omnivoresNutr Neurosci2015728929610.1179/1476830514Y.0000000164Fergus C. Comparison of sugar intakes between vegetarian and non-vegetarian adolescent females [thesis]. Dunedin: Universidad de Otago; 2019 [cited 2022 Sep 25]. Available from: https://ourarchive.otago.ac.nz/bitstream/handle/10523/9961/FergusClaraA2019MDiet.pdf?sequence=1FergusC.Comparison of sugar intakes between vegetarian and non-vegetarian adolescent femalesthesisDunedinUniversidad de Otago20192022 Sep 25Available from: https://ourarchive.otago.ac.nz/bitstream/handle/10523/9961/FergusClaraA2019MDiet.pdf?sequence=1Jasarevic T, Thomas G. La OMS abre una consulta pública acerca del proyecto de directrices sobre los azucares [Internet]. Ginebra: Organización Mundial de la Salud; 2014 Mar 5 [cited 2022 Sep 25]. Available from: https://www.who.int/es/news/item/05-03-2014-who-opens-public-consultation-on-draft-sugars-guideline#:~:text=Nueva%20recomendaci%C3%B3n&text=Un%205%25%20de%20la%20ingesta,%C3%ADndice%20de%20masa%20corporal%20normal JasarevicTThomasG.La OMS abre una consulta pública acerca del proyecto de directrices sobre los azucares [Internet]GinebraOrganización Mundial de la Salud2022 Sep 25Available from: https://www.who.int/es/news/item/05-03-2014-who-opens-public-consultation-on-draft-sugars-guideline#:~:text=Nueva%20recomendaci%C3%B3n&text=Un%205%25%20de%20la%20ingesta,%C3%ADndice%20de%20masa%20corporal%20normalChavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr 2009;63(1):78-86. https://doi.org/10.1038/sj.ejcn.1602904ChavarroJERich-EdwardsJWRosnerBAWillettWCA prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertilityEur J Clin Nutr2009631788610.1038/sj.ejcn.1602904Mariotti F, Gardner C. Dietary protein and amino acids in vegetarian diets: a review. Nutrients. 2019;11(11):2661. https://doi.org/10.3390/nu11112661MariottiFGardnerC.Dietary protein and amino acids in vegetarian diets: a reviewNutrients201911112661266110.3390/nu11112661Parker H, Vadiveloo M. Diet quality of vegetarian diets compared with nonvegetarian diets: a systematic review. Nutr Rev. 2019;77(3):144-60. https://doi.org/10.1093/nutrit/nuy067ParkerHVadivelooM.Diet quality of vegetarian diets compared with nonvegetarian diets: a systematic reviewNutr Rev201977314416010.1093/nutrit/nuy067Hertzler SR, Lieblein-Boff JC, Weiler M, Allgeier C. Plant proteins: assessing their nutritional quality and effects on health and physical function. Nutrients. 2020;12(12):3704. https://doi.org/10.3390/nu12123704HertzlerSRLieblein-BoffJCWeilerMAllgeierC.Plant proteins: assessing their nutritional quality and effects on health and physical functionNutrients202012123704370410.3390/nu12123704Preedy VR, Watson RR, Patel VB, editors. Nuts and seeds in health and disease prevention. London: Academic Press; 2011. https://doi.org/10.1016/B978-0-12-375688-6.10004-0 PreedyVRWatsonRRPatelVBNuts and seeds in health and disease preventionLondonAcademic Press201110.1016/B978-0-12-375688-6.10004-0Complications. Vitamin B12 or folate deficiency anaemia [Internet]. England: NHS; 2019 [cited 2022 Sep 25]. Available from: https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/complications/#:~:text=If%20you’re%20pregnant%2C%20not,the%20brain%20and%20spinal%20cordComplicationsVitamin B12 or folate deficiency anaemia [Internet]EnglandNHS20192022 Sep 25Available from: https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/complications/#:~:text=If%20you’re%20pregnant%2C%20not,the%20brain%20and%20spinal%20cordRogne T, Tielemans M, Chong, Yajnik CS, Krishnaveni GV, Poston L, et al. Maternal vitamin B12 in pregnancy and risk of preterm birth and low birth weight: A systematic review and individual participant data meta-analysis. Am J Epidemiol. 2017;185(3):212-23. https://doi.org/10.1093/aje/kww212RogneTTielemansMChongYajnikKrishnaveniGVPostonLMaternal vitamin B12 in pregnancy and risk of preterm birth and low birth weight: A systematic review and individual participant data meta-analysisAm J Epidemiol2017185321222310.1093/aje/kww212Neufingerl N, Eilander A. Nutrient intake and status in adults consuming plant-based diets compared to meat-eaters: a systematic review. Nutrients. 2022;14(1):29. https://doi.org/10.3390/nu14010029NeufingerlNEilanderA.Nutrient intake and status in adults consuming plant-based diets compared to meat-eaters: a systematic reviewNutrients2022141292910.3390/nu14010029Plank, R. Sicherheit und Risiken vegetarischer und veganer Ernährung in Schwangerschaft, Stillzeit und den ersten Lebensjahren. Monatsschr Kinderheilkd. 2019;167:22-35. https://doi.org/10.1007/s00112-018-0554-7PlankRSicherheit und Risiken vegetarischer und veganer Ernährung in Schwangerschaft, Stillzeit und den ersten LebensjahrenMonatsschr Kinderheilkd2019167223510.1007/s00112-018-0554-7Tonstad S, Butler T, Yan R, Fraser G. Type of vegetarian diet, body weight, and prevalence of Type 2 Diabetes. Diabetes Care. 2009;32(5):791-96. https://doi.org/10.2337/dc08-1886TonstadSButlerTYanRFraserG.Type of vegetarian diet, body weight, and prevalence of Type 2 DiabetesDiabetes Care200932579179610.2337/dc08-1886Zelaya A, Sinibaldi E. Is vegetarianism a solution for obesity and NCDs? A review. Food Sci Nutr. 2021;12(3):249-61. https://doi.org/10.4236/fns.2021.123020ZelayaASinibaldiE.Is vegetarianism a solution for obesity and NCDs? A reviewFood Sci Nutr202112324926110.4236/fns.2021.123020